PMID- 36804223 OWN - NLM STAT- MEDLINE DCOM- 20230404 LR - 20230405 IS - 1532-8422 (Electronic) IS - 1053-0770 (Linking) VI - 37 IP - 5 DP - 2023 May TI - The Clinical Application of Ultra-Fast-Track Cardiac Anesthesia in Right-Thoracoscopic Minimally Invasive Cardiac Surgery: A Retrospective Observational Study. PG - 700-706 LID - S1053-0770(23)00009-5 [pii] LID - 10.1053/j.jvca.2023.01.010 [doi] AB - OBJECTIVES: The purpose of this study was to investigate the effect of ultra-fast-track cardiac anesthesia (UFTCA) on rapid postoperative recovery in patients undergoing right-thoracoscopic minimally invasive cardiac surgery. DESIGN: A retrospective observational study. SETTING: A single large teaching hospital. PARTICIPANTS: A total of 153 patients who underwent right-thoracoscopic minimally invasive cardiac surgery between January 2021 and August 2021 were enrolled. The inclusion criteria were American Society of Anesthesiologists grade I to III, New York Heart Association (NYHA) cardiac function class I to III, and age >/=18 years. The exclusion criteria were NYHA class IV, local anesthetic allergy, severe pulmonary hypertension (pulmonary arterial systolic pressure, PASP >70 mmHg), age /=80 years old, emergency surgery, and patients with incomplete or missing data. INTERVENTIONS: Finally, a total of 122 patients were included and grouped by different anesthesia strategies. Sixty patients received serratus anterior plane block-assisted ultra-fast- track cardiac anesthesia (UFTCA group), and 62 patients received conventional general anesthesia (CGA group). The primary outcomes were lengths of hospital stay and postoperative intensive care unit (ICU) stay. The secondary outcomes were postoperative pain scores, opioids use, postoperative chest tube drainage, and complications. MEASUREMENTS AND MAIN RESULTS: The intraoperative dosages of sufentanil and remifentanil in the UFTCA group were significantly lower than those in the CGA group (66.25 +/- 1.03 microg v 283.31 +/- 11.36 microg, p < 0.001; and 1.94 +/- 0.38 mg v 2.14 +/- 0.99 mg, p < 0.001, respectively). The incidence of postoperative rescue analgesia in the UFTCA group was significantly lower than that in the CGA group (10 patients [16.67%] v 30 patients [48.38%], p < 0.001). In the postoperative ICU, there were fewer patients with pain score Numeric Rating Scale >/=3 in the UFTCA group than that in the CGA group (10 patients [16.67%] v 29 patients [46.78%], p < 0.001). The postoperative extubation time in the UFTCA group was shorter than that in the CGA group (0.3 hours [range, 0.25-0.4 hours] v 13.84 hours [range, 10.25-18.36 hours], p < 0.001). Lengths of ICU stay and hospital stay in the UFTCA group were shorter than those in the CGA group (27.73 +/- 16.54 hours v 61.69 +/- 32.48 hours, p < 0.001; and 8 days [range, 7-9] v 9 days [range, 8-12], p < 0.001, respectively). Compared with the CGA group, the patients in the UFTCA group had less chest tube drainage within 24 hours after surgery (197.67 +/- 13.05 mL v 318.23 +/- 160.10 mL, p < 0.001). There were no significant differences in in-hospital mortality, postoperative bleeding, or secondary surgery between the 2 groups. The incidences of postoperative nausea, vomiting, or atelectasis were comparable between the 2 groups. CONCLUSIONS: Serratus anterior plane block-assisted ultra-fast-track cardiac anesthesia can promote rapid postoperative recovery in patients with right-thoracoscopic minimally invasive cardiac surgery. This anesthesia regimen is clinically safe and feasible. CI - Copyright (c) 2023 The Authors. Published by Elsevier Inc. All rights reserved. FAU - Jiang, Shenjie AU - Jiang S AD - Rehabilitation Medicine Center, Department of Anesthesiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China. FAU - Wang, Lixin AU - Wang L AD - Jinzhou Medical University NO 40, Jinzhou City, Liaoning Province, China. FAU - Teng, Haokang AU - Teng H AD - Jinzhou Medical University NO 40, Jinzhou City, Liaoning Province, China. FAU - Lou, Xiaokan AU - Lou X AD - Rehabilitation Medicine Center, Department of Anesthesiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China. FAU - Wei, Hanwei AU - Wei H AD - Rehabilitation Medicine Center, Department of Anesthesiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China. FAU - Yan, Meijuan AU - Yan M AD - Rehabilitation Medicine Center, Department of Anesthesiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China. Electronic address: 1514018695@qq.com. LA - eng PT - Journal Article PT - Observational Study PT - Research Support, Non-U.S. Gov't DEP - 20230113 PL - United States TA - J Cardiothorac Vasc Anesth JT - Journal of cardiothoracic and vascular anesthesia JID - 9110208 RN - P10582JYYK (Remifentanil) RN - 0 (Analgesics, Opioid) SB - IM MH - Humans MH - Adolescent MH - Aged, 80 and over MH - *Anesthesia, Cardiac Procedures MH - Remifentanil MH - Analgesics, Opioid MH - Anesthesia, General MH - Pain, Postoperative/diagnosis/epidemiology/etiology MH - *Cardiac Surgical Procedures/adverse effects OTO - NOTNLM OT - minimally invasive cardiac surgery OT - serratus anterior plane block OT - thoracoscope OT - ultra-fast track cardiac anesthesia COIS- Conflict of Interest None. EDAT- 2023/02/23 06:00 MHDA- 2023/04/04 06:42 CRDT- 2023/02/22 08:34 PHST- 2022/04/05 00:00 [received] PHST- 2022/12/15 00:00 [revised] PHST- 2023/01/08 00:00 [accepted] PHST- 2023/04/04 06:42 [medline] PHST- 2023/02/23 06:00 [pubmed] PHST- 2023/02/22 08:34 [entrez] AID - S1053-0770(23)00009-5 [pii] AID - 10.1053/j.jvca.2023.01.010 [doi] PST - ppublish SO - J Cardiothorac Vasc Anesth. 2023 May;37(5):700-706. doi: 10.1053/j.jvca.2023.01.010. Epub 2023 Jan 13.